By Gary Crum, guest columnist
The Oregon state legislature has determined not to provide additional funding for the construction of a state mental hospital near Junction City. However, the state hospital administration has decided to use $20 million, which was left over from construction of the Salem campus of Oregon State Hospital, to further develop the project. The proposed construction will involve site construction and it will begin the construction of the building’s foundation.
I have been assured by State Senator Chris Edwards that, during the next legislative session, there will be a “clean” discussion of the relative merits of locked-ward hospital treatment vs. community-based programs, and this discussion will determine the future of the hospital project.
However, it’s very clear to me that the hospital administration is working to avoid that conversation and dialogue.
As Edwards knows, all stakeholders — patient advocates, professional organizations, the Oregon State Hospital Advisory Board and the federal government — strongly support community-based services.
At this juncture, the Junction City-area state-owned property could be used for a multitude of governmental functions. It could be developed as a campus for community-based residential programs for the mentally ill; it could be the site for the Veteran’s Administration clinic slated to be built in the greater Eugene area; it could be a service park for future state and federal government offices and service centers; it could be many different things. It has the proper zoning (public facilities); it has infrastructure in place to serve it; it’s in an excellent location, near major highways and the Eugene airport. In sum, it offers tremendous potential for South Valley governmental services siting.
However, once foundation work for the new state hospital building is begun, I predict hospital administration will simply say, “Look, we’ve gone too far to change course now. We can’t waste taxpayer dollars by deciding to change our minds. We must go forward with the hospital as planned.”
What we must do is simple: We must stop construction on the actual buildings. This may prevent the legislature from a final, absolute commitment to locked-ward hospital treatment as the direction the state wants to take for the future of treatment of the mentally ill.
I offer the following comments, hoping that our legislators will listen, and begin an open and inclusive dialogue to determine a better future.
And, I suggest that, when that dialogue occurs, those legislators will be convinced that state resources are best directed toward a cascade of community-based services, rather than focused on an extremely expensive commitment to hospital-based placement.
The decision to build or not to build a new $100 million mental hospital near Junction City will determine the focus of treatment for Oregon’s mentally ill population for years to come.
If the state decides to fund hospital construction, it will be committed to over $100 million in construction costs, and additional annual operating expenses of over $48 million (174 beds at $280,000 per bed per year).
This huge expenditure will drastically curtail funding for the development and operation of community-based services — community-based residential facilities, community mental health clinics, outpatient treatment and community-based crisis care. Funding the hospital’s construction and then its operation will put all our mental health care dollars in one basket — and in my opinion, it’s the wrong basket.
Every stakeholder group engaged in this debate has publicly and vehemently opposed the hospital’s construction: every patients’ advocacy group has opposed it; every mental health professional organization has opposed it; the governor-appointed Oregon State Hospital Advisory Board has opposed it and written a very strong letter of opposition to legislators. The U.S. Department of Health and Human Services spoke with its wallet in opposition to large, locked-ward facilities. Community-based treatment and services receive a 50 to 60 percent federal subsidy; locked-ward facilities such as the proposed Junction City hospital receive none. The Junction City proposal is both wrong-headed and hugely expensive.
The guiding principle of mental health care and treatment is “the least restrictive appropriate setting possible.” Locked-ward placement is the most restrictive placement on the continuum of services for the mentally ill. Funding the Junction City hospital will represent a commitment to continue that funding and that extreme level of treatment, at a direct “opportunity loss” cost to all other placement and treatment options. Oregon, especially in these difficult economic times, simply cannot fund this facility and develop and support other, less restrictive, treatment options.
Even the proponents of building the hospital acknowledge that we do, indeed, need to move toward community-based treatment programs and services, but they claim another locked-ward facility is a necessary step toward those programs. This argument is akin to suggesting the best way to drive from Eugene to Portland is to first travel to Medford. Rather than taking us closer to that goal of community-based mental health treatment, the hospital’s construction takes us much farther away from that goal.
Most of the debate centers on forensic patients, individuals who have committed crimes, but are adjudicated “not guilty” due to mental illness, and sent to the hospital rather than being processed further into the criminal justice/penal system.
Based on August 2011 data, 40 percent of Oregon’s forensic patients were committed for crimes which were not Measure 11 felonies. Had these individuals not been judged mentally ill and instead were convicted of such crimes, they would have been sentenced to either very short periods of incarceration or placed on probation.
Most of these patients could be treated in the community at a much lower cost (about 14 percent of the cost of hospital placement), receive more appropriate treatment, and more readily transition back into the community. Importantly, they would present no risk to other patients, staff or the community.
In addition to forensic patients, locked-ward mental hospitals across the country, including Oregon, have an increasing population of geropsychiatric (older) patients, many quite elderly and infirm, who could be placed in community-based facilities with absolutely no risk to anyone.
We’re both violating the mandate for “least restrictive setting” and wasting tens of millions of tax dollars with these locked-ward placements — or, if you will, “misplacements.”
The simplest and most economical approach to forensic patient care is to provide proactive support; care, treatment and supervision before they commit crimes leading to their hospital placement; i.e., help them avoid becoming forensic patients.
Most (virtually all) forensic patients have long histories of mental illness. They are individuals who when living in our communities received maintenance levels of psychotropic medications to treat, primarily, schizophrenia and bipolar disorder. They function quite well in the community so long as they maintain that therapeutic level of medication. However, nearly all psychotropic drugs have rather unpleasant side-effects: nausea, headaches, muscle and joint pain, stomach and digestive problems and, often, impotence and loss of libido. Problems arise when individuals taking these medications decide to “self-UNmedicate” — to, on their own, reduce or terminate their medications. Most of the incidents leading to forensic placement occur when such patients are “off their meds” and in the throes of a psychotic episode.
We need community resources to help these individuals continue their medication at an appropriate level. We need outpatient support groups and individual therapy and counseling support. We need outpatient clinics with physicians and psychiatrists to help adjust medications and doses to minimize side effects. We need, when appropriate, nurse practitioners to supervise court-ordered medication dosing. We need community-based residential facilities with a continuum of security levels to house patients. We need community crisis centers for temporary secure placement to provide short-term detention, observation and evaluation and, when needed, to facilitate the re-establishment of therapeutic levels of medication.
We need the legislature to address this important topic with open minds, and to listen to the strong arguments for these community-based services which patient advocates, professionals in the field, and the Oregon State Hospital Advisory Board have put forward, to terminate the Junction City hospital project, and redirect funding toward proactive community-based programs and facilities.
The state hospital administration is working very hard to avoid the discussion we need, by forging on with construction of the hospital without the genuine, informed support and approval of the legislature.
Gary Crum is a resident of Junction City, Oregon. He has been active in opposing the construction of a new psychiatric institution there.